INFECTION CONTROL ISSUES

CINS workbook draft 9.1 (adult) 76 bottles of alcohol gel are carried by individual staff, in accordance with NPSA recommendations. Hands should be washed with liquid soap and water after several consecutive applications of alcohol hand rub.

GLOVES MUST BE WORN for all invasive procedures. They should be disposed of as clinical waste and hands decontaminated after removal.

Disposable plastic aprons should be worn when there is a risk the clothing may be exposed to blood, body fluids secretions or excretions .

An aseptic, non touch technique (ANTT) should be used for catheter site care and accessing the system. Following hand antisepsis, clean gloves and an ANTT or sterile gloves should be used when changing the insertion site dressing, line manipulation or during IV drug administration

Administration sets to be changed in accordance with the CINS guidelines

All of these precautions are necessary to avoid any extrinsic or intrinsic sources of infection in IV therapy.

Figure 8.2 Extrinsic and intrinsic sources of infection in IV therapy

Copyright of the Infection Control Nurses Association; Guidelines for preventing intravascular catheter-related infection (2001)

CINS workbook draft 9.1 (adult) 77 Table 8.1 How organisms invade in IV therapy.

Catheter Insertion

Creates an open pathway for skin organisms to enter the patients‟ bloodstream.

This is the most common infection route.

Accessing the Catheter

Medication, Flushing, Tubing / cap changes all introduce micro organisms into the lumen. Hub manipulation is the most common source of infection in long-term catheters.

Infection

Organisms affecting other sites or systems can move to the foreign object (VAD) and cause a Catheter Related Bloodstream Infection (CRBSI).

Contaminated fluid or medication

Considered rare. Outbreaks of HIV, Hep B & C have been attributed to contaminated multi-dose vials. Polymicrobal outbreaks have also been traced to large bags of saline solution being used for multiple catheter flushes.

(Hadaway 2006)

Getting the Terminology Right

Many different terms are used to describe the process used to reduce the risk of contamination when manipulating lines; Aseptic technique, strict aseptic technique, sterile technique, clean technique. Many of these terms are poorly defined in the literature and often used interchangeably. Below is some definations to the common terms used when dealing with vascular access devices.

Sterile Technique

Sterile means, “free from all micro-organisms”. This technique seeks to totally eliminate all micro-organisms from the procedure. Owing to the natural abundance of microorganisms in the environment it is not possible to achieve a true sterile technique for most IV procedures in an environment such as the ward or patients home – even when wearing sterile gloves. Sterile technique can only really be performed in highly controlled environments such as a laminar airflow cabinet or theatre.

CINS workbook draft 9.1 (adult) 78 Aseptic technique

Asepsis means, “free from infection or infectious (pathogenic) microorganisms”.

For a venous access device related infection to occur, it must be contaminated by a sufficient number of virulent, pathogenic organisms. Therefore the chances of catching an infection can be reduced by just eliminating the pathogenic micro-organisms. Aseptic technique is a set of specific practices and procedures performed under carefully controlled conditions with the goal of minimizing contamination by pathogens. Unlike sterile technique it is achievable in the clinical setting as it doesn‟t seek to eliminate all micro-organisms.

Aseptic Non-Touch Technique (ANTT)

Aseptic Non-Touch Technique maintains asepsis by being non-touch in nature. It identifies “Key parts” used in a procedure that if contaminated would increase the risk of infection. These “key parts” should be protected at all times, and should only come into contact with other sterile “Key parts”. It can be used as a technique on its own or combined with more conventional aseptic techniques to further reduce the possible occurrence of contamination as good hand hygiene cannot always be assured, and gloves can be contaminated during the procedure (Rowley 2001). ANTT requires the practitioner to make a risk assessment as to whether they can perform the procedure without touching the key parts. If they can then non-sterile gloves are permitted as well as a more relaxed aseptic filed (because the “Key parts” are always protected through a non-touch technique). If they can‟t then a more traditional aseptic technique must be employed which includes the use of sterile gloves. The principals of ANTT are based on rigid set of guidelines which must be followed; this reduces the chances of variations in practice and associated poor practice. However for ANTT to work successfully it is essential that staff are trained, regularly updated and that practice is audited.

Key parts

Key parts are parts of the equipment that if contaminated would increase the risk of infection occurring. In IV therapy these are usually parts that come into contact with blood or liquid for infusion (Rowley 2001).

CINS workbook draft 9.1 (adult) 79 Should gloves be worn when preparing and administering IV medications?

The answer is YES. Wear sterile gloves if you cannot avoid touching the key parts of the equipment OR wear non-sterile if you can. Wearing gloves will not only ensure you are adhering to COSH regulations, but will also ensure that key parts are protected from any skin that may shed from your hands during the procedure (Rowley 2001).

In conclusion, it cannot be emphasised enough that the risks from infection can have catastrophic consequences for patients in your care. You therefore have a duty to be aware of the risks and the evidence based measures necessary to reduce them.

Reflection 8

Focusing on the equipment and your knowledge of ANTT and key parts, identify the “key parts” in the preparation and administration of IV medications. Give the reason why you think it is a key part.

Key part Reason

________________________ _________________________

________________________ _________________________

________________________ _________________________

________________________ _________________________

________________________ _________________________

________________________ _________________________

________________________ _________________________

CINS workbook draft 9.1 (adult) 80 Activity 8

Ask a colleague to observe you perform hand washing using the Ayliffe technique. Obtain their feedback. Alternatively, use the posters available on your ward (or figure 8.2) to guide you in your hand washing practice.

CINS workbook draft 9.1 (adult) 81 9. HOME INTRAVENOUS THERAPY

Reasons for Home Care

Patients with infections are often hospitalised for weeks or months in order to receive intravenous antibiotics. Other patients have to travel quite a distance to get their intravenous access device flushed or checked. The aim of home care is to enable patients to receive the treatment they require within their own home environment once a thorough risk assessment has been completed.

Table 9.1 Clinical Conditions currently treated within the home with IV Therapy

o Endocarditis o Cellulitis o Osteomyelitis o MRSA

o Spinal abscess o Lung abscess

o Soft tissue infections o Haematological oncology

o Palliative care eg removal of chemotherapy

o (Home Parenteral Nutrition )- by specialist teams ?? some IV teams do not undertake this procedure.

o Renal patients o Bronchiectasis o UTI

The Advantages of home IV Therapy

The advantages of home therapy can be grouped under three main headings;